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[白塞病中的认知障碍]

[Cognitive disorders in Behçet's disease].

作者信息

Ovcharov P S, Lisitsyna T A, Veltishchev D Yu, Burenchev D V, Ishchenko D A, Seravina O F, Kovalevskaya O B, Alekberova Z S, Nasonov E L

机构信息

Nasonova Research Institute of Rheumatology, Moscow, Russia.

Serbsky National Medical Research for Psychiatry and Narcology, Moscow Research Institute of Psychiatry, Moscow, Russia.

出版信息

Zh Nevrol Psikhiatr Im S S Korsakova. 2019;119(2):11-17. doi: 10.17116/jnevro201911902111.

Abstract

AIM

To study the prevalence of cognitive disorders (CD) and clinical/pathogenetic correlations of CD in patients with Behçet's Disease (BD).

MATERIAL AND METHODS

One hundred and six BD patients were enrolled in the study. The majority of patients were natives of the North Caucasus (51.9%). Mean age was 33.3±0.98 years, mean illness duration 148.5±10.4 months. All the patients met the criteria of the International Study Group for BD (1990) classification. The disease activity was assessed by scoring system BDCAF. A diagnosis of a mental disorder (MD) was established by the psychiatrist in accordance with the ICD-10 using a semi-structured interview. The Montgomery-Asberg Depression Rating Scale (MADRS), the Hamilton Anxiety Rating Scale (HAM-A), a pathopsychological method 'Pictograms', clinical/psychological methods for assessment of cognitive functions (memory, attention concentration, logic thinking) were administered. Brain MRI was done in 44 (41.5%) BD patients. The study was conducted in the frames of the interdisciplinary program 'Stress factors and mental disorders in immune-mediated inflammatory rheumatic diseases'.

RESULTS

CD of mild to moderate severity were diagnosed in 82 (77.4%) and anxiety-depressive disorders in 81 (76.4%) of BD patients. The patients with CD were older compared to patients without cognitive disorders (34.3±1.07 vs 29.0±2.14, p=0.006). Patients with CD were most often (84.1% vs 50.0%, p=0.001) diagnosed with anxiety-depressive disorder (anxiety, chronic/recurrent depression). MADRS scores were higher (16.1±0.74 vs 12.2±1.06, p=0.005) though did not exceed the moderate level. The impact of chronic psychosocial stressors was detected more often in CD patients. MRI results showed that the frequency of chronic multifocal, predominantly subcortical, changes in the white matter was higher in CD patients.

CONCLUSION

CD are characteristic of most patients with BD. They are associated with the age, anxiety-depressive disorders, chronic stressors and minor brain multifocal subcortical parenchymal MRI lesions.

摘要

目的

研究白塞病(BD)患者认知障碍(CD)的患病率及其临床/发病机制相关性。

材料与方法

106例BD患者纳入本研究。大多数患者为北高加索地区本地人(51.9%)。平均年龄为33.3±0.98岁,平均病程148.5±10.4个月。所有患者均符合国际白塞病研究组(1990年)分类标准。采用BDCAF评分系统评估疾病活动度。精神科医生根据ICD - 10,通过半结构化访谈确诊精神障碍(MD)。采用蒙哥马利 - 阿斯伯格抑郁评定量表(MADRS)、汉密尔顿焦虑评定量表(HAM - A)、病理心理学方法“象形图”以及评估认知功能(记忆、注意力集中、逻辑思维)的临床/心理学方法。44例(41.5%)BD患者进行了脑部MRI检查。本研究在跨学科项目“免疫介导的炎性风湿性疾病中的应激因素与精神障碍”框架内开展。

结果

82例(77.4%)BD患者被诊断为轻至中度严重程度的CD,81例(76.4%)患者被诊断为焦虑抑郁障碍。与无认知障碍的患者相比,有CD的患者年龄更大(34.3±1.07岁 vs 29.0±2.14岁,p = 0.006)。有CD的患者最常被诊断为焦虑抑郁障碍(焦虑、慢性/复发性抑郁)(84.1% vs 50.0%,p = 0.001)。MADRS评分更高(16.1±0.74 vs 12.2±1.06,p = 0.005),但未超过中度水平。在CD患者中更常检测到慢性心理社会应激源的影响。MRI结果显示,CD患者中慢性多灶性、主要为皮质下白质改变的频率更高。

结论

CD是大多数BD患者的特征。它们与年龄、焦虑抑郁障碍、慢性应激源以及脑部轻微多灶性皮质下实质MRI病变相关。

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